A Meta-Ethnography of Women's Intimate and Sexual Experiences Across the Menopause Continuum

Women's intimate and sexual experiences during midlife are shaped by complex biopsychosocial factors, warranting focused attention in research and clinical practice. A hormonal shift in the menopause transition period may cause symptoms such as vaginal dryness, thinned mucosa, and painful intercourse. Other symptoms include decreased libido, and difficulty achieving orgasm during sexual activity. With more women reaching midlife, there is more need to understand how physiology and psychology impact their intimate relationships and overall health. The purpose of this review was to explore published qualitative studies on women's sexual experiences including function, satisfaction, and challenges during midlife and the menopause continuum. A meta-ethnographic approach was conducted to synthesize all relevant qualitative studies. We searched on the Web of Science, Scopus, and CINAHL for studies published between 2010 and September 2024. Of 1,361 studies identified, 53 studies encompassing diverse cultural contexts met the inclusion criteria and were synthesized. Three main themes were identified: physical symptoms and cultural influences on sexuality during menopause and midlife; emotional, psychological, and relational responses to sexual and bodily changes, including shifts in self-perception, body image, emotional well-being, and relationship dynamics; and adapting to sexual changes during the midlife and menopause transition. The review highlights that biological changes alone are insufficient to fully understand midlife and menopausal women's sexual experiences, emphasizing the need for a biopsychosocial approach to provide holistic care. Greater attention should be given to midlife women's sexual health and well-being by raising awareness and encouraging open discussions about menopause and sexual changes. Healthcare professionals play a critical role in recognizing the psychological impacts of these changes and facilitating conversations to help women feel comfortable discussing sensitive topics. The review highlights the need for future research to explore women's experiences of menopause and sexual health and well-being across diverse cultural contexts, with particular attention to non-Western countries where such perspectives remain underrepresented.